To determine the amount of ketones (ketone bodies, acetoacetate, beta-hydroxybutyrate, and acetone) in the blood to help diagnose a life-threatening problem called diabetic ketoacidosis

When To Get Tested?

When you have symptoms associated with ketoacidosis, such as increased urination, excessive thirst, dehydration, rapid breathing, and shortness of breath

Sample Required?

A blood sample drawn from a vein in your arm or from a fingerstick

Test Preparation Needed?

None

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The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

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Ketones or ketone bodies are byproducts of fat metabolism. This test measures the amount of ketones in the blood.

Ketones are produced when glucose is not available to the body's cells as an energy source and/or when the body cannot use glucose as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead. When fat is metabolized, byproducts called ketone bodies build up in the blood, causing first ketosis and then progressing to ketoacidosis, a form of metabolic acidosis. This condition is most frequently seen with uncontrolled type 1 diabetes and can be a medical emergency.

There are three ketone bodies – acetoacetate, beta-hydroxybutyrate, and acetone. Acetoacetate is created first. Beta-hydroxybutyrate is created from acetoacetate. Acetone is a spontaneously created side product of acetoacetate. Beta-hydroxybutyrate is the predominant ketone body present in severe diabetic ketoacidosis (DKA). Different ketone tests measure one or more ketone bodies, and their results are not interchangeable.

Blood testing gives a snapshot of the status of ketone accumulation at the time that the sample was collected. Urine ketone testing reflects recent rather than current blood ketones. Urine testing is much more common than blood ketones testing. It may be performed by itself, with a urine glucose test, or as part of a urinalysis. The urine methods measure either acetoacetate or acetoacetate and acetone but do not usually detect beta-hydroxybutyrate.

Blood ketones may be measured in a laboratory or with a handheld monitor. The laboratory test uses serum, the liquid portion of the blood, and typically measures acetoacetate. Beta-hydroxybutyrate can be ordered as a separate blood test.

When whole blood from a fingerstick is tested for ketones using a handheld monitor, the monitor measures beta-hydroxybutyrate. This test may be performed at a person's bedside in a hospital or emergency room, in a doctor's office, or performed by a person at home.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm or by pricking a finger.

DKA is associated with sudden and severe high blood glucose (acutehyperglycemia), a severe insulin deficiency, and a disruption of the body's acid-base balance. Excess ketones and glucose are dumped into the urine by the kidneys in an effort to flush them from the body. This causes increased urination, thirst, dehydration, and a loss of electrolytes. The affected person may also experience symptoms such as rapid breathing, shortness of breath, a fruity scent to the breath, nausea, vomiting, fatigue, confusion, and eventually coma.

Ketosis and ketoacidosis may also be seen with starvation, alcoholism, and with high-fat, low-carbohydrate diets. It may be induced on purpose in some children with epilepsy who have frequent seizures and do not respond to available medications or other treatments.

There are three ketone bodies: acetoacetate, beta-hydroxybutyrate, and acetone. Beta-hydroxybutyrate is the predominant ketone body present in severe diabetic ketoacidosis. Different ketone tests measure one or more ketone bodies, and their results are not interchangeable. (See the "What is being tested?" section for more.)

Blood ketones are sometimes ordered, along with other tests such as blood gases, glucose, and electrolytes, to detect ketoacidosis in non-diabetics if they have signs and symptoms of DKA due to, for example, ingestion of excessive amounts of alcohol.

Blood ketone tests may be ordered when someone with diabetes has symptoms associated with diabetic ketoacidosis (DKA) and may also be performed whenever there is the potential for DKA to develop, such as when a diabetic is sick or pregnant. With the availability of home monitoring, blood ketones can be ordered as frequently as the person's healthcare provider recommends. Some signs and symptoms of ketoacidosis include:

Recent studies have shown that serum ketones and beta-hydroxybutyrate testing are both effective in diagnosing diabetic ketoacidosis (DKA). Some healthcare practitioners prefer beta-hydroxybutyrate. In acute DKA, the ketone body ratio (beta-hydroxybutyrate:acetoacetate) rises from normal (1:1) to as high as 10:1. In response to insulin therapy, beta-hydroxybutyrate levels commonly decrease long before acetoacetate levels. However, beta-hydroxybutyrate is not available in all laboratories.

They are related but not the same thing. While increases in ketones are associated with high glucose concentrations, they can also occur with moderate glucose levels in many conditions, such as when you are sick.

In many cases, yes, urine is tested much more frequently than blood. However, since it will not detect beta-hydroxybutyrate, the main ketone body with diabetic ketoacidosis (DKA), your healthcare provider may prefer that you monitor your blood.

Yes, although it is not as common as in type 1 diabetes. It may occur in type 2 diabetes, especially when you have a severe infection or illness. Ketosis and ketoacidosis may also be seen in non-diabetics, people with starvation, alcoholism, and with high-fat, low-carbohydrate diets. It may be induced on purpose in some children with epilepsy who have frequent seizures and do not respond to available medications or other treatments.

(May 2011) Sacks D. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Clin Chem. Available online at http://www.ncbi.nlm.nih.gov/pubmed/21617152. Accessed June 2016.

(Apr 2011) Stojanovic V. Role of beta-hydroxybutyric acid in diabetic ketoacidosis: A review. Can Vet J. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058661/. Accessed June 2016

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